AB1463 CHARACTERISTICS AND MORTALITY OF PATIENTS WITH AUTOIMMUNE RHEUMATIC DISEASES ADMITTED TO THE INTENSIVE CARE UNIT.
Authors: J. P. Baldivieso, E. Miguelez Tato, C. Valero, F. Gutiérrez-Rodríguez, C. Alvar González, D. Rodriguez Serrano, A. García-Vadillo
Journal: Annals of the Rheumatic Diseases (2022)

Background Autoimmune rheumatic diseases (ARD) are associated with multiple organ dysfunction, which may require admission to Intensive Care Units (ICU), constituting a challenge for rheumatologists and intensivists. The new immunomodulatory treatments may be changing the characteristics and mortality of these patients. Objectives The primary objective of the study is to know the mortality and the characteristics related to this event of our patients admitted to the ICU in the last 5 years. The secondary objective is to compare the characteristics of our series with the series of our patients admitted to the ICU in the previous decade. Methods We conducted a retrospective transversal observational study using computerized medical records. A database was created with patients with ARD admitted to the ICU of the Princess University Hospital between October 1, 2015 and September 30, 2020, excluding those with a stay of less than 24 hours. Information was collected about the characteristics and treatments of the disease prior to their admission to the ICU, as well as the clinical characteristics and therapeutic measures established in the ICU during their stay. Statistical analysis was performed using SPSS. Results After ruling out admissions of less than 24 hours, a population of 45 patients with a mean age of 65.3 ± 12.2 years and 69% women were included. Connectivopathies (40%) and rheumatoid arthritis (37.8%) were the most prevalent ARDs that required admission to the ICU. Cardiovascular events (51%) were the main reason for ICU admission, followed by infectious processes (27%). The median ICU stay was 5 days. It is striking that 77% of the patients had received glucocorticoids prior to admission throughout their disease. The median score on the severity scales was 34 in SAPS II and 17 in APACHE II. Mortality during the ICU stay was 30.4% and in the multivariate analysis it was associated with the previous administration of glucocorticoid boluses and the APACHE II scale score. This mortality is higher compared to historical series of patients admitted to Spanish ICUs with similar APACHE II severity scores. In the comparative study with the previous period, similar mortality rates were observed, an increase in the mean age of those admitted, a decrease in patients with vasculitis and an increase in patients with rheumatoid arthritis. Likewise, an increase in cardiovascular events is observed as a fundamental reason for admission to the ICU. Conclusion The mortality of our patients with ARD admitted to the ICU in the last five years is 30.4%, similar to the previous decade but higher than the observed in other pathologies with similar severity characteristics. It is related to the APACHE II score and to the prior administration of glucocorticoid boluses. Connectivopathies and rheumatoid arthritis are the diseases that are most frequently admitted to the ICU and the fundamental reasons are cardiovascular events and infections. Disclosure of Interests None declared